Cochrane Reviews are systematic reviews of research in health care and policy. They are internationally recognized as a high-quality source of evidence for decision-making. They collate and summarize all the best available research evidence on the effects of healthcare interventions or the accuracy of diagnostic tests into a systematic review.

The purpose of a Cochrane DTA review is very like the purpose of a conventional Cochrane systematic review. Using explicit, transparent, and systematic methods to pool together all the available evidence relevant to a DTA research question, we can obtain more precise estimates of the accuracy of diagnostic tests than single DTA studies alone can provide. Estimates of sensitivity and specificity may also be more generalizable than estimates from single studies.

Among its many international collaborators, Cochrane GNOC Group works with key contributors who are interested in disseminating evidence about the accuracy tests for diagnosing cancer. We spoke with three contributors, Jo Morrison, Co-ordinating Editor of Cochrane GNOC, KateSanger, Head of Communications & Public Affairs, Jo's Cervical Cancer Trust and Nuala Livingstone, Editor of the Cochrane Editorial Unit, to discuss the importance of this Review:

How important was this Cochrane Review to produce?

Jo Morrison: The review compares the accuracy of two different methods of testing cervical smears in picking up pre-cancerous changes (known as high grade cervical intra-epithelial neoplasia – HG CIN). Both tests start with a smear test, taken by directly visualising the cervix and using a ‘broom’ or spatula to sweep cells off the cervix. The difference is in what is done with the test once it is in the pot. One test puts cells onto a slide so they can be examined under a microscope and is called cytology, often called a Pap test. The other test takes a sample of cells and checks for the presence of viruses that can lead to pre-cancerous changes in the cervix (HG CIN). These viruses are called high risk Human Papilloma Virus or HR HPV. The test for the virus looks for genetic material (either DNA or RNA depending on the test) using a process called the polymerase chain reaction (PCR) and does not rely on someone looking at cells down a microscope.

Kate Sanger: This review is timely, as in the UK it has been announced that testing for HPV as the primary cervical screening test is to be rolled out over the coming years. We are in a position where the implications of this change on the workforce, systems and indeed patients are at the top of the agenda. The aim of the screening programme is to reduce incidence and mortality from cervical cancer through identifying women who are more at risk of the disease and providing treatment where appropriate. The confirmation through this review that screening for HPV is more sensitive and therefore more effective at identifying cases of CIN 2 or greater is extremely welcome and positive.

What did they find?

Jo Morrison: This DTA review found 40 studies comparing the two tests in over 140,000 women who had a smear test. Testing a smear test for HR HPV is less likely to miss HG CIN, as it is a more sensitive test than cytology. However, if the test is positive there is a lower chance that there really is HG CIN, as it is a less specific test. For every 1000 women who had a smear test, 20 actually had HG CIN. Cytology (Pap test) would have correctly identified 12 of these women (but missed 8 women with HG CIN); HPV testing would have correctly identified 16 women (and missed 4). The test is therefore more sensitive and has fewer false negative tests than cytology. However, this increased sensitivity comes at a cost. The HPV test would have suggested that 101 women had HG CIN when in fact they did not, whereas only 29 women would have had an over-call (false positive) with cytology (Pap) testing. This would result in an increase in women needing to be referred to a clinic for colposcopy, were the HPV test used as a stand-alone test, causing increased anxiety for these women. This is because the test is less specific and has more false positive test results than cytology.

What does this mean for clinical practice?

Jo Morrison: For the UK, this will mean that we can change the cervical screening programme. Currently all smears are screened for cytology first and those with features of low grade dyskaryosis are ‘triaged’ using HPV testing – those with HR HPV detected are referred to colposcopy. And those with no HR HPV are returned to routine re-call. However, mathematically, it makes more sense to use the most sensitive test (HPV test) up-front and then use cytology on those found to have HR HPV. By introducing a second level test after HPV testing, fewer false positives will be generated and fewer women will require colposcopy than with HPV testing alone. However, this change will have major implications for the screening programme since: 1) more women may be referred to colposcopy; 2) overall many fewer smears will require cytological evaluation. This has repercussions for the current laboratory services, since many fewer cytopathology screeners will be required and the service could be streamlined to only a few laboratories providing this service across the UK (since there are minimum numbers of smears screened per screener to maintain expertise).

World-wide this has major benefits since HPV testing is much more easily deliverable in the developing world that cytological screening, which is where the heaviest burden of disease from cervical cancer lies.

Kate Sanger: For patients, there is a clear need for increased information provision regarding why the changes to the screening programme are beneficial and the different pathways women invited for screening may take depending on the outcome of their initial HPV test. For women testing negative for HPV it is essential that they fully understand the need to continue to attend screening when next invited; greater symptom awareness for all women must also be increased. It is especially important that women who test positive for high risk HPV, but do not have cell changes that require treatment, fully understand what it means, for example with women starting new relationships or who may have multiple sexual partners. This is essential to reduce uncertainty, distress and to ensure being ‘HPV positive’ does not get a negative stigma attached to it. Information and support need to be available to women at every stage with clinicians able to signpost women to external sources.

How robust is this evidence?

Nuala Livingstone: Overall, I would consider this evidence to be robust. The review authors have provided detailed, and carefully considered information in this review to assist the user in assessing the ‘robustness’ of the evidence.

Firstly, they assessed the methodological quality of the included studies using the QUADAS tool, as recommended by the Cochrane Diagnostic Test Accuracy Working Group. This assessment revealed that most the included studies in this this review were ‘low risk of bias’. Review authors also assessed the quality of the body of evidence for each outcome in the Cochrane review using the GRADE considerations. This assessment considers the methodological quality of the included studies (as assessed by QUADAS) along with the precision, consistency, completeness and applicability of the evidence available. Based on these factors, review authors judged the overall quality of the evidence in this review to range from moderate to high. Evidence was downgraded from ‘high’ to ‘moderate’ quality because the sensitivity values among included studies were slightly inconsistent, with values ranging from 52%-94% for Cytology, and 61% to 100% for HPV testing.

Kate Sanger: It would be interesting to see a breakdown of the research by age group, as women under 25 and over 65 were part of the study and in the UK these women are not invited for screening. Data on women over 65 could contribute to evidence as to whether there should be a consideration of increasing the screening age in the UK. With women under 25 further research into the impact of the HPV vaccination on incidence will be particularly important, especially following the potential introduction of Gardasil 9.

How clinically relevant is it, and how can the evidence be used?

Jo Morrison: This review is highly clinically relevant and affects all women in a screened population – ideally it should be relevant to all women world-wide, since universal cervical screening would be a major contributor to global health and the burden of disease is largely in less developed countries.

What would your message be to clinicians and policy-makers in this area or cervical screening?

Jo Morrison: HPV-testing has increased sensitivity, but less specific than cytology. Used as the up-front test in a two-stage screening test, it has the potential to reduce the number of false-negative tests, thereby reducing the number of ‘interval’ cancers, which are missed by cytologyical screening. There are also potentials for cost savings, although this review did not perform an economic evaluation.

What would your message be to patients?

Nuala Livingstone: The high sensitivity of this test should provide reassurance that a negative result on this test is highly likely to be accurate. This finding is supported by moderate to high quality evidence, which suggests we can be fairly certain in the result. However, a positive result will not necessarily prove to be true.

Jo Morrison: HPV testing is much less likely to miss changes than conventional cytology, although this may come at the price of more women needing referral to colposcopy for someone to look at their cervix and possibly perform biopsies. It is hugely reassuring to have a negative HPV test, since this shows that the risk of having CIN is very low. There is the possibility that the interval between smear tests could be extended, reducing the frequency that women need smears, which nobody enjoys! However, this would need to be tested in a different sort of study than a DTA study.

What further research would you like to see, and what would this tell us?

Jo Morrison: The results of studies comparing screening programmes using conventional cytological screening up-front versus HPV screening up-front are in progress and initial results demonstrate that this is likely to reduce the number of cancers missed by the screening test due to false negative smear results.

Kate Sanger: This review provides evidence which will hopefully increase activity to ensure the roll out of HPV primary in the UK is not delayed. It also provides a range of considerations that policy makers and clinicians need to address to ensure the physical and emotional health of the women in their population is protected. We must however not lose sight that across the UK attendance of screening is in worrying decline and addressing this, regardless of the screening test, must remain a priority.

Nuala Livingstone: The results of this review have provided detailed an important information regarding the statistical evidence available for this research question. However, I would like to see further research that provides information regarding the clinical importance of the evidence, and the long-term implications for women.

Jo Morrison, Nuala Livingstone, Kate Sanger.Jo, Nuala and Kate’s words stated and expressed in this blog are entirely personal, and do not represent any official views or opinions of Cochrane.

CGNOCCGNOC are committed to providing reliable evidence required to make important decisions on issues concerning Gynaecological cancers, Neuro-oncology and related topics.

CGNOC's main task is to facilitate the identification of reports of controlled clinical trials and to carry out systematic reviews which are then published on the Cochrane Library. The reviews are updated as new evidence is identified. This ensures that Cochrane reviews are relevant, useful, usable and used.

Evidence relating to the care of people with cancer comes from a number of sources and so a multi-faceted approach is taken, including searching electronic databases of clinical trial reports, handsearching printed journals, and scanning of the 'grey' literature i.e. conference proceedings and abstracts. Every effort is made to find unpublished trials to avoid bias.

f you would like more information about proposing a review title or getting involved with the Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, please contact us:

Jo’s Cervical Cancer Trust is the only UK charity dedicated to women affected by cervical cancer and cervical abnormalities. Our vision is a future where cervical cancer is a thing of the past. We want to see cervical cancer prevented and the impact for everyone affected by cervical abnormalities and cervical cancer reduced. We do this through providing the highest quality information and support, and campaigning for excellence in cervical cancer treatment and prevention. www.jostrust.org.uk

August 2017: The Cochrane Official Blog is curated and maintained by the Communications & External Affairs Department. To submit items for publication to the blog or to add comments to a blog, please email news@cochrane.org.

Cochrane UK is seeking an organized and enthusiastic individual to join our small, friendly team at the UK Cochrane Centre in the role of Events and Office Coordinator. This is an exciting time to join us, as we are organizing a global healthcare evidence conference for 1200 delegates in September 2018. This role is vital to the organization of the event and offers an opportunity, as a 14-month post, to organize and deliver an inspiring and successful conference.

Main responsibilities include day-to-day running of the office, coordination of our training programmes, diary management and events organization.

Essential requirements:

Excellent planning and organizational skills

Excellent customer service and interpersonal skills

Ability to work autonomously to find solutions

Keen interest in learning new skills

This is a full-time maternity cover band 5, NHS employed position, based in Summertown, Oxford. It would suit a highly motivated individual, with previous experience in organising events, who works well as part of a team, is adaptable, enjoys communicating with a wide range of people and is keen to contribute to a global effort to produce reliable, accessible healthcare evidence.

Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health. We are a not-for-profit organization with contributors from more than 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. We do this by producing reviews that summarize the best available evidence generated through research to inform decisions about health. Cochrane Systematic Reviews are published online, in full text, in the Cochrane Database of Systematic Reviews in the Cochrane Library

Cochrane UK is one of 14 Cochrane Centres around the world supporting the global work of Cochrane. Cochrane UK is funded by the National Institute for Health Research (NIHR) and hosted by the Oxford University Hospitals NHS Trust. The centre supports the production of Cochrane systematic reviews through a learning and development programme. We also aim to maximize the impact of Cochrane reviews by disseminating the findings widely to health professionals, researchers, commissioners, the public, charities and the media, through social media, events, presentations and partnerships.

John Wiley and Sons Inc. (NYSE:JWa) (NYSE:JWb) is pleased to announce that students, practitioners, researchers, and patients in India will now have access to more than 7,000 published systematic reviews in healthcare interventions through one-click access to the Cochrane Library. Cochrane is a leading resource in evidence-based research across areas including pregnancy, mental health, surgical procedures, and public health. Cochrane Reviews provide independent high-quality evidence to aid healthcare decision making.

The collaboration between Wiley, Cochrane, and the National Medical Library in India offers free access, through IP recognition, to the Cochrane Library across India. This opportunity has been made possible thanks to the National Medical Library and will provide more than 1.3 billion residents of India availability to the gold standard in evidence-based healthcare research. The license will run from 2017 to 2020.

Dr K P Singh, Director of the National Medical Library, welcomed the move: “This national license will have a great impact on the quality of evidence and research used in healthcare interventions across India. We are very committed to future-proofing our healthcare system and by enabling one-click free access to the Cochrane Library we are looking after our population.”

More than 1,300 Indian researchers have contributed to Cochrane research. This demonstrates the importance of the new national license. Access to the best research in the world is key to developing young practitioners’ careers but also offers patients and other interested parties access to the latest interventions in health care. According to the Medical Council of India, as of 2017 there are 460 recognized medical colleges with a combined capacity to provide medical education for 63,985 students. The Medical Council of India's motto is “to provide quality medical care to all Indians through promotion and maintenance of excellence in medical education.” Its website maintains an up-to-date list.

Deputy Editor in Chief of the Cochrane Library, Karla Soares-Weiser, welcomed today’s announcement: “All countries need to ensure that scarce and limited health resources are used as effectively as possible. A national license provides India with unlimited access tothe Cochrane Library. This is an important springboard for the further development of evidence-informed health care across India.”

Cochrane is a global independent network of researchers, professionals, patients, careers, and people interested in health. The organization gathers and summarizes the best evidence from research to help make informed choices about treatment. More than 37,000 Cochrane contributors from over 130 countries work together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. There are 53 Review Groups covering a variety of health topics, from Infectious Disease to Oral Health to Pregnancy and Childbirth.

Deborah Pentesco-Gilbert, Editorial Director, Cochrane at John Wiley & Sons said, “A national license is a fantastic opportunity to ensure evidence-based healthcare interventions are reaching all parts of India. Whether it’s a university researcher reviewing the latest findings, a general practitioner seeking current best practices, or a patient looking for the new treatment options, we are thrilled to provide gold-standard healthcare interventions through the Cochrane Library.”

About Cochrane Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. Find out more at www.cochrane.org or follow on twitter @cochranecollab. The Cochrane Libraryis published by Wiley.

About Wiley Wiley, a global company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical, and scholarly journals, combined with our digital learning, assessment and certification solutions help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 200 years, we have delivered consistent performance to our stakeholders. The company's website can be accessed at www.wiley.com.

The Department of Clinical Sciences has an exciting opportunity for a Managing Editor to work in the Cochrane Infectious Diseases Group

The Liverpool School of Tropical Medicine (LSTM) is an internationally recognised centre of excellence for research in tropical diseases. This includes the Centre for Evidence Synthesis in Global Health, which houses the Cochrane Infectious Diseases Group (CIDG), one of the first Cochrane Groups and highly successful, and well known for its exacting standards.

As the Managing Editor of CIDG you will help organize review production across over 600 authors from some 52 countries. These reviews are around the effects of healthcare interventions for infectious diseases, particularly malaria, tuberculosis, diarrhoea, tropical diseases and HIV/AIDS. You will be interacting with Editors from CIDG of international repute, working closely with the dynamic team of in-house researchers, administrators and communication specialists as well as authors and partners who are part of the Effective Health Care Research Programme Consortium. You will also be the link between the existing and potential authors who need support for the Cochrane Reviews. As a representative of CIDG, you will participate in events and working groups and ensure that developments on both sides are communicated and updated. You will be responsible for the day to day management of the CIDG Editorial team in addition to implementing the CIDG strategic plan.

It is essential for this role that you possess a postgraduate degree in biomedical science or a health-related subject, with proven experience in writing up medical or biomedical scientific research clearly and concisely. If you have been involved in working with Cochrane Reviews, or systematic reviews, and have experience of technical editing; including copy editing/proof reading in medicine or biomedical science, it will also be an added advantage. Given the wide scope in people management and interactions, the job holder must have worked with and managed teams from diverse backgrounds and qualifications. The successful candidate must be able to demonstrate scientific writing skills, have advanced IT and excellent project management skills, as well as the ability to adapt to new software. Given the nature of the role, you must be able to travel nationally and internationally.

Latest evidence published in the Cochrane Library suggests that taking a multivitamin supplement that includes vitamin E, carotenoids (beta-carotene or lutein or zeaxanthin), vitamin C, and zinc may slow down the progression of the common eye disease age-related macular degeneration (AMD).

Age-related macular degeneration (AMD) is a progressive and sight-threatening disease affecting the central area of the retina and affects large numbers of people across the world. Population-based studies suggest that in older people (80 years and older), approximately one in three people have early signs of the disease.

There are numerous unanswered questions in the treatment of AMD. There has been a growing perception amongst eyecare professionals that taking vitamin supplements and antioxidants, such as lutein and zeaxanthin, may protect patients against the progression of the eye disease.

A team of Cochrane researchers conducted a study to assess whether taking antioxidant vitamin and mineral supplements slows down the progression of AMD in people with a diagnosis of AMD. They collected and analyzed data from 19 studies involving men and women from Australia, China, Europe, and the USA.

Lead author Jenny Evans from the London School of Hygiene & Tropical Medicine explains more:

How important was it to update this Cochrane Review?This is a topic that is currently of much interest to people with AMD. The review was last updated in 2012 and we knew that there were new studies available.

What did you find?We found 19 studies that compared various types of vitamins against placebo in people with AMD. The evidence was mixed, but there was one large study in the USA that suggested that a particular combination of these vitamins may slow down the progression of the disease.

We did not find evidence that these supplements on their own were so useful.

What does this mean?If you have a diagnosis of AMD, then vitamin supplements may be helpful.

How robust is this evidence?The evidence is not so robust. Most of the evidence comes from one large study from the USA which followed people up over six years. The other studies in the review were small and shorter duration and less conclusive.

What would your message be to eyecare practitioners?People with AMD may be interested in taking vitamin supplements. The benefits and harms should be explained clearly.

What would your message be to patients already taking vitamin supplements for AMD?The decision as to whether or not to take vitamin supplements is up to you. You may wish to discuss these again at your next visit to your eyecare practitioner.

What does this mean for patients who think they are at higher risk of progression of the disease?Vitamin supplements are generally regarded as safe. They may be helpful but your vision may deteriorate further, even if you take these supplements. Regular visits to your eyecare practitioner are advised.

What further research would you like to see, and what would this tell us?It would be good to have a large trial comparing a supplement containing vitamin C, E, lutein, zeaxanthin, and zinc with taking no supplement for people with AMD to see if this slows down progression to visual loss.

Age-related macular degeneration (AMD) is a progressive and sight-threatening disease affecting the central area of the retina and affects large numbers of people across the world. Population-based studies suggest that in older people (80 years and older), approximately one in three people have early signs of the disease.

There are numerous unanswered questions in the prevention of AMD. There has been a growing perception amongst eyecare professionals that taking vitamin supplements - in particular, antioxidant supplements such as lutein and zeaxanthin - may protect patients against the onset of the eye disease.

A team of Cochrane researchers conducted a study to assess whether taking antioxidant vitamin and mineral supplements prevents the development of AMD.

They collected and analysed data from five studies involving men and women from Australia, USA, and Finland.

Lead author Jenny Evans from the London School of Hygiene & Tropical Medicine explains more:

How important was it to update this Cochrane Review?This is a topic that is currently of much interest to people in the general population. The review was last updated in 2012 and we knew that there were new studies available.

What did you find?We found five large studies that compared taking vitamin E, beta-carotene, vitamin C, and multivitamin with taking a placebo in people in the general population.

People taking these supplements had a similar chance of developing AMD compared with people not taking the supplements. We did not find any relevant studies of lutein and zeaxanthin in the general population.

What does this mean?If you are healthy, with a healthy diet, and you do not have problems with your eyes, then taking vitamin supplements is not necessary.

How robust is this evidence?The evidence is robust. The studies were large (more than 75,000 people) and were well conducted. There is an evidence gap for whether or not to take lutein or zeaxanthin to prevent AMD.

What would your message be to eyecare practitioners?Be aware that there is no evidence that antioxidant supplements prevent AMD.

What would your message be to patients already taking vitamin supplements to prevent AMD? The decision as to whether or not to take vitamin supplements is up to you. Vitamin supplements are generally regarded as safe. You may wish to discuss these again at your next visit to your eyecare practitioner.

What does this mean for patients who think they are at higher risk of contracting the disease?The decision as to whether or not to take these supplements is up to you. If you choose not to take them, you are unlikely to be putting yourself at greater risk of developing AMD.

What further research would you like to see, and what would this tell us?It would be good to have a large trial comparing lutein and zeaxanthin with taking no supplement in people who have not yet developed AMD. The aim would be to see whether taking supplements reduces the chance of developing this condition.

We are delighted to announce the results of the recent elections and appointments to the Governing Board:

Co-Chair:

Martin Burton has been appointed by the Board as its Co-Chair for a term of two years. Martin served as a member of the Board until this month, and already has substantial leadership experience in Cochrane as Director of Cochrane UK and Co-ordinating Editor of the Cochrane Ear Nose & Throat Review Group. Martin is based in Oxford, UK, and will share chairing duties with Cindy Farquhar, who is Co-ordinating Editor of the Gynaecology and Fertility Review Group, and is based in Auckland, New Zealand.

Two internal members:

The election of internal members of the Governing Board has now concluded, and you have elected the following two candidates for a term of three years:

Tracey Howe - director of the Cochrane Global Ageing Field and based in Glasgow, UK.

Joerg Meerpohl - serving Board member who has now been re-elected. Co-Director of Cochrane Germany and based in Freiburg, Germany.

Three external members:

The Board has appointed three external members of the Board for a term of three years:

Maria Gladys Faba Beaumont - sociologist by training and works with the National Institute of Public Health in Mexico and the Pan American Heath Organization; based in Mexico City

David Hammerstein Mintz - civil society advocate for the Commons Network, an organization that he co-founded, former Member of the European Parliament and based in Valencia, Spain.

Rae Lamb - Aged Care Complaints Commissioner for Australia and has a background in health journalism and health services research; based in Melbourne.

Cochrane congratulates and welcomes the new members and extends its grateful thanks to Lisa Bero, outgoing Co-Chair; and Mona Nasser and Denise Thomson, outgoing Board members, for their outstanding contributions to Cochrane as members of the Board.

Cochrane and the Guidelines International Network (G-I-N) have been formal partners since 2014. We work together collaboratively to ensure that evidence is both useful and used by people making decisions about health, from individuals to clinicians to international health policy-makers from all over the world.

The latest collaboration between Cochrane and G-I-N is a new release of Cochrane's TaskExchange platform, which extends TaskExchange's remit to include tasks related to developing guidelines.

This role is an exciting opportunity to use your administration experience to make a difference in the field of health care research.

Working as part of a team, the Administrator will handle a variety of office support tasks such as servicing meetings, making travel arrangements, diary management and maintaining electronic records. The role also includes dedicated support for our External Affairs team, administering funding applications, maintaining donor reports and managing contact databases.

We are looking for an efficient and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world. The successful candidate will also have:

Previous experience of providing administrative support.

Intermediate level IT skills, including Word, Excel and PowerPoint.

Excellent written and verbal communication skills.

Excellent interpersonal skills.

Professional telephone manner.

Ability to work methodically and accurately.

A flexible approach with the ability to respond quickly to issues as they arise.

A pro-active approach to problem-solving.

Awareness of handling confidential and sensitive information.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information. An understanding of Cochrane’s work and the healthcare charity sector more generally is an advantage, but not essential.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with ‘Administrator’ in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples. List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

Cochrane is a global independent network of researchers, professionals, and people interested in health, including healthcare consumers. Cochrane's healthcare consumers are made up from a wide range of people, including patients (or people with personal experience of a healthcare condition), health and social care service users, caregivers and family members. Also included are people who represent or are advocates for patients and carers. What unites them all is their search for high quality, unbiased information about health conditions and treatments.

Consumer involvement is vital to Cochrane’s work as it:

(i) promotes transparency, accountability and trust in the way that research is produced;(ii) results in evidence that addresses consumers’ needs, reduces waste in research, improves the translation of research into policy and practice, and ultimately leads to improved benefits for health systems and outcomes for patients;(iii) is consistent with current health research approaches and is expected or mandated by our funders, partners and consumers.

The value of consumer involvement

Cochrane believes that the benefits of consumer involvement are best realised when consumers contribute throughout the process of production and dissemination of research. Specifically, consumer involvement can contribute to Cochrane’s goals as follows:

GOAL 1: Producing evidenceConsumers can influence the way research is planned and carried out, including by nominating and helping to prioritise Cochrane review topics; helping to frame research questions and identifying relevant outcome measures; evaluating the impact of evidence; and participating in Citizen Science such as Cochrane Crowd. There is also an opportunity to work alongside researchers and clinicians to co-produce research, including participating as researchers and co-authors.

GOAL 2: Making our evidence accessibleConsumers can comment on systematic reviews, protocols and plain language summaries, ensuring that reviews address questions that are important, relevant and understandable. Consumers can work with authors, Review Groups, Fields and Centres to promote Cochrane evidence and decision making by helping to develop innovative ways of presenting evidence, telling their own stories or speaking on behalf of other patients, and promoting evidence through their networks, partner organisations and social media.

GOAL 3: Advocating for evidenceConsumers can help promote evidence-based healthcare in general and Cochrane evidence through campaigning, explaining and sharing knowledge about evidence-based practice, research and evidence with other consumers, patient organisations and networks.

GOAL 4: Building an effective & sustainable organizationConsumers can contribute to the leadership and governance of Cochrane at national and international levels by being part of Review Groups, Fields and Centres, by serving on the Cochrane Council and by putting themselves forward for election to Cochrane’s Governing Board. Consumers can be recruiters, and champions for consumer involvement, as well as mentoring and sharing their knowledge and expertise with other consumers. They can help to develop Cochrane resources and practice, as well as building and sustaining partnerships and alliances with groups that can disseminate and promote Cochrane evidence.

The guiding principles of consumer involvement

Cochrane’s work is based on its 10 key principles. In addition, consumer involvement in Cochrane will be guided by the following: equity, inclusiveness and partnership.

EquityCochrane recognizes that consumers altruistically volunteer their time, experience, knowledge and skills and it acknowledges and values the contribution of consumers equally with all other Cochrane collaborators and members. Equity requires that consumers – as with all collaborators, supporters and members – enjoy similar opportunities for meaningful involvement in Cochrane’s work, clarity of expectation for that work, and adequate support to do that work in the form of effective communication, induction, training, and reimbursement of expenses (where applicable).

InclusionCochrane recognises that consumer involvement is vitally important to the process of governance, and the production and dissemination of Cochrane evidence. Our consumer and membership base should be as representative as possible of the population that Cochrane seeks to serve. Cochrane recognises and respects the diversity of its consumer contributors, values people’s differences in the way they contribute, and acknowledges that promoting an inclusive approach to their involvement means that consumers can contribute to their full potential.

PartnershipConsumer involvement in Cochrane is a key part of the production of Cochrane evidence. It can vary in extent and depth, from reviews which are guided by the contributions of consumers, to those where consumers control aspects of the review in which their lived experiences give them particular expertise (co-production). Consumer involvement adds significant value to reviews and Cochrane seeks to maximise these contributions through active consumer involvement in the governance of the organisation and the entire review and dissemination process. Cochrane aspires to develop its partnership with consumer volunteers throughout the whole research cycle.

Cochrane’s commitment to its contributing consumers

1. Cochrane will value its consumer volunteers, and recognises that individual consumers want to offer contributions according to their needs, experiences, skills and abilities, language and availability.2. Cochrane will strive to be flexible and responsive to encourage a wide variety of levels and types of involvement from individual consumers in all its work.3. Cochrane will ensure that its contributing supporters and members, including consumers, are properly welcomed, inducted, trained and supported.4. Cochrane will support its contributing authors, Review Groups, Fields, Centres and other entities with resources and learning opportunities to better support consumer involvement.5. Cochrane will ensure that consumers’ contributions are properly acknowledged and recognised.6. Cochrane will communicate effectively with its consumers, including offering constructive feedback.7. Cochrane will aim continually to improve the way that it involves consumers. It will regularly evaluate the effectiveness of its practice, including understanding the consumer experience, leading to the establishment and improvement of standards of consumer involvement.

Recent injuries in two major sporting events: Wimbledon and the Tour de France. Helen Handoll, Co-ordinating Editor of Cochrane Bone, Joint and Muscle Trauma and Senior Reserarch Fellow at Teeside Univerity, takes a look at sports injuries and evidence. Dr Handoll research interests focus on getting the evidence to inform the management of people with hip, shoulder and wrist fractures, either via primary research or conducting Cochrane systematic reviews.

Wimbledon is upon us – yippee for all tennis fans – and the spectre of sports injury is on Centre Court. Two matches stopped early for leg injuries, with some grumblings over whether they should have started in the first place. The various pressures on sportsmen and women to play despite injury have been highlighted. Even being on court can be bruising, with one line judge being struck by the ball three times during one match.

More spectacular and badly timed was Mark Cavendish’s crash into a barrier at 60 km/h during the Tour de France. With a broken shoulder, he is now out of the race. This is the same shoulder that Cavendish dislocated at the opening stage of the Tour in 2014, which I blogged about here.

It is now established that Cavendish has suffered a fracture to his scapula, which is an uncommon shoulder fracture. Fortunately, there was no nerve damage and the team doctor announced that surgery would not be required. A picture shows Cavendish sporting an extensive shoulder immobiliser which allows him to rest his shoulder while healing takes place.

Typically for serious injuries, surgery promises better restoration of anatomy, better stability while healing takes place and potentially in the long term, and the prospect of earlier mobilisation and return to function. Especially to athletes, the potential for an earlier return to sport can be a major reason for opting for surgery. However, these aims may not be achieved, and surgery comes at the risk of surgery-related complications, such as infection and extra injuries resulting from the surgery itself.

What about the evidence?

It is dismaying to find that conclusive evidence is not available to inform on or confirm the role of surgery for the types of collarbone fractures or ankle sprains where there is uncertainty about its use. For ACL rupture, there is already a greater onus on surgery that concurs with the strong preference for surgery by athletes and other physically active people. As the Cochrane review on ACL rupture concludes, the research question has shifted from whether surgery is needed soon after injury to one where early ACL reconstruction surgery is compared with a formal option for ACL reconstruction surgery later on if criteria relating to knee instability are met.

Making treatment decisions

Elite athletes such as Cavendish are exceptions and, as well as having an extraordinary level of fitness before their injury, have a team of people advising them about these decisions and helping restoring them to peak condition. Treatment decisions, including surgery, for the rest of us who have sustained these injuries will depend on different factors. Irrespective, it remains important to know where there is reliable evidence and where there is uncertainty in making health choices. And finally to remember that evidence-based decision making is a combination of best available evidence, clinical expertise and patient values and preferences.

Dementia is the focus of a blog series running throughout July on Evidently Cochrane . Many of us are caring for a family member with dementia, know someone with dementia, or may be looking ahead to our own futures, perhaps wondering what we could do to avoid or delay developing dementia ourselves. There are also many working in health and social care, and numerous third sector organisations, looking after and supporting people with dementia; and researchers working to change the future of dementia. There can’t be very many of us not touched by dementia in some way.

Take a look at these Evidently Cochrane blog posts featuring Cochrane Review evidence:

This year is the 20th anniversary of the establishment of the firstCochranecentre in Spain. It was founded in 1997 as the Spanish Cochrane Centre and was located at the Corporació Sanitària Parc Taulí in Sabadell. On 2000,thecentre was renamed as Iberoamerican Cochrane Centre (IbCC) and has continued its activity at its current headquarters in the Hospital de la SantaCreui Sant Pau in Barcelona.

To celebrate this 20years of history, the centrehelda Conference on May, 24thand 25th –within the framework of CIBERESP– to observe the different aspects related to this initiative and to offer training activities. The conference was held in the Casa de Convalescencia, one of the Art Nouveau venues of the hospital, and Mark Wilson participated in the opening of the event together with Jaime Kulisevsky (Director of the Biomedicinal Research Institute Sant Pau), and Xavier Bonfill (Director of the Iberoamerican Cochrane Network). The projection of two videos, from Elena Andradas (Director of Public Health, Quality and Innovation, Spanish Ministry of Health) and from a representative of the Spanish Organisation of Consumers and Users, completed the opening.

The topics of the different panel discussions held the first day of the event were “How are the systematic reviews needed today and how can we use them better?”–with the participation of Karla Soares (Deputy Editor in Chief) talking about new horizons of Cochrane reviews–, “Methodological tools to answer research questions”; and several Systematic Reviews experiences.

On May, 25th there were several workshops about GRADE and Systematic Reviews –free under registration– taught by members of the Iberoamerican Cochrane Network.

Furthermore, the evening before the Conference, the former and current IbCN staff threw a party to celebrate the anniversary. The event included different types of musical and comedy performances. Some of our former staff members and friends contributed to this lovely evening by sending their greetings via video from all over the world.

Two new Cochrane Reviews are the last in a series of related systematic reviews summarizing evidence on the effects of different interventions for treating obesity and overweight in childhood and adolescence.

The reviews summarize the results of 114 studies which involved more than 13,000 children and young people. They show that a combination of diet, physical activity, and behavioural change interventions may reduce weight in children aged six to 11 years and in adolescents aged 12 to 17, but there are limitations in the studies and variation in the results.

Childhood and adolescent obesity is one of the leading global public health concerns. Rapid weight gain in children as young as six years old has increased globally, and has significant mental and physical health consequences such as diabetes, high blood pressure, asthma, sleep problems, and low self-esteem. Obesity in childhood and adolescence can persist into adulthood, increasing the risk of poor health in later life.

Both these latest Cochrane Reviews will inform ongoing work by the World Health Organization. The two reviews look at the effects of diet, physical activity, and behavioural interventions in treating children with overweight or obesity from six years old to early adulthood. They are the last two reviews in a series of six that covers surgery, drug therapy, interventions targeting parents only, and lifestyle interventions for children of pre-school age.

The childhood review looks at evidence from 70 studies conducted in over 8,000 six to 11-year-olds from Europe, the USA, Canada, New Zealand, Australia, Japan, and Malaysia. Most studies compared behaviour-changing interventions with no treatment or usual care. The majority of trials (65/70) involved both the child and their parents or caregivers.

The quality of the evidence was low but suggests that compared to no treatment or usual care, interventions incorporating combinations of diet, physical activity, and behaviour change may have a small, short-term effect in reducing children’s weight and body mass index-z score (a proxy measure of body fat based on weight in relation to height, sex, and age). The researchers know less about the effects of diet, physical activity, and behaviour change on self-esteem and quality of life, because few of the trials looked at these outcomes. There was a very low occurrence of side effects; two studies reported a small number of side effects, but these were not considered to be related to taking part in the studies.

The review of adolescents found 44 completed studies including just under 5,000 young people with overweight or obesity aged between 12 to 17 years. Fifty additional studies are still ongoing and have not yet reported their results. Most studies assessed the combined effects of diet, physical activity, and behavioural change interventions, but there was variation in the content and duration of the interventions and their delivery, and the comparators used. There was moderate-quality evidence that combinations of diet, physical activity, and behaviour change reduce an adolescent’s weight by about three and a half kilos, and low-quality evidence that these interventions may reduce body mass index by just over one kg/m2. These effects were maintained in longer term trials which lasted for up to two years. The findings from this review also suggest a moderately improved quality of life, but did not find firm evidence of an advantage or disadvantage for improving young people’s self-esteem, physical activity, and food intake.

The results of the studies varied in both reviews, and the authors looked at possible reasons for this. However, they could not definitively explain the variation in the results of the studies. They could not find differences in the results when looking at different types of intervention, the setting of the intervention, or whether parents were involved in the interventions. Both reviews highlight the need for more research to explore the variation between the study results more fully.

Dr Emma Mead, who led the six-to-11-year-old review as part of her PhD at the School for Health and Social Care, at Teesside University, UK, says these findings complete a very complex picture on a globally important health topic: “These reviews are important because they provide the most up-to-date evidence to show that behaviour changing interventions can help treat children with overweight and obesity. However, we need to do more work to understand how to maintain the positive effects of the intervention after it has finished, and understand which interventions work best in lower income countries, and for families from different socio-demographic backgrounds.”

Dr Lena Al-Khudairy, Research Fellow from the Division of Health Sciences at the University of Warwick, UK, who led the review of adolescents, said: “Approaches that combine several interventions can be effective to tackle overweight and obesity in teenagers, but we still need to know more about what specific components are most effective and in whom, and importantly learn more about adolescents’ views about the interventions.”

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On behalf of Cochrane Croatia’s host institution, Prof. Zoran Đogaš, the Dean of the University of Split School of Medicine, gave the opening address at the Centre celebration, expressing his support of Cochrane Croatia’s work, which he confirmed the following day in the signing of the Collaboration Agreement between Cochrane, Cochrane Croatia and UoSSoM. Full support was also offered by the Director of the Croatian Centre for Global Health, Prof. Ozren Polanšek, Assistant Director of the University Hospital in Split, Dr. Anton Marović, representative of the Croatian Medical Chamber, Assist. Prof. Željko Puljiz, the Chancellor of the University of Split, Prof. Šimun Anđelinović and the State Secretary of the Minister of Health, Dr. Željko Plazonić. Letters of support were received from the Office of the President of the Republic of Croatia, the Minister of Science and Education, the president of the Croatian Medical Association, and others.

The Croatian Ambassador to Canada from 2005-2010, Ms. Vesela Mrđan Korać, spoke of the diplomacy required to establish collaboration between the University of Split and the University of Ottawa, which led to the foundation of Cochrane Croatia, as well as the important role of Croatian expats in Ottawa, notably family Mamić, in hosting directors of Cochrane Croatia during their study visits to Cochrane Canada. Others who have been instrumental in the foundation of Cochrane Croatia, such as Prof. Matko Marušić, Prof. Livia Puljak, and Assist. Prof. Dario Sambunjak, shared their vision of Cochrane Croatia with all those present. Those who unfortunately couldn’t be present sent heartfelt messages, including, Prof. Peter Tugwell and Jordi Pardo, from Cochrane Canada, Prof. Roberto D’Amico, director of Cochrane Italy, Prof. Žarko Alfirević, from Cochrane Pregnancy and Childbirth and Prof. Davor Štimac, from Cochrane Hepato-Biliary.

The future of Cochrane Croatia was the focus of the final part of the Centre celebration; hence our main speakers were Mark Wilson, Cochrane’s CEO, Prof. Gerd Antes, Director, Cochrane Germany, and representatives of Cochrane Croatia’s partner organizations. Attendees were entertained by traditional Dalmatian singers and dancers, as well as by the Student Choir of the UoSSoM. The event would not have been possible without the support of our sponsors: Tourist Office of the City of Split, Redak Print Studio, Enter Digital Studio and Radio Sun.

The following day, Mark Wilson opened the 9th Croatian Cochrane Symposium, dedicated to the topic of ‘Evidence based dental medicine’. We were very honoured to have as our main speakers Jan Clarkson, Helen Worthington, and Anne-Marie Glenny from Cochrane Oral Health. The two-day symposium included lectures, workshops, a poster walk and lively interactions, and was attended by participants from Croatia, Bosnia-Herzegovina, and Poland.

Associate Professor Julian Elliott from Cochrane Australia in the School of Public Health and Preventive Medicine at Monash University has been awarded the prestigious Commonwealth Health Minister’s Award for Excellence in Health and Medical Research 2017 at a ceremony in Melbourne last night. The medal is bestowed annually to the top-ranked Career Development Fellowship applicant through the National Health and Medical Research Council.

A Career Development Fellowship (CDF) is a highly competitive, four-year fellowship that supports the most outstanding early- to mid-career health and medical researchers. The medal for best application comes with an additional $50,000 research grant to be used by Associate Professor Elliott on top of his CDF funding.

Associate Professor Elliott’s work focusses on novel systems for translating research into practical healthcare solutions that positively affect patient health and quality of life. He says,“Doing research is not enough. We also need to make sure the findings of research translate into action and improved health – but there is now so much research it is hard for anyone to make sense of this ‘data deluge’. My team and our collaborators are developing and evaluating novel health data systems that make sense of health research and accelerate the translation of research into improved, evidence-based health care.”

Associate Professor Elliott’s work focusses on methods and systems to successfully gather, process and meta-analyse all research data relevant to a particular health question. This includes the development of ‘living’ systematic reviews – high quality summaries of research that are updated whenever new research is produced. These systems incorporate text mining, artificial intelligence, online software platforms, and ‘citizen science’.

For example, Covidence is a software platform that is used around the world to produce systematic reviews; and Cochrane Crowd is a citizen science platform with over 5,000 members. This platform has demonstrated that given appropriate training, members of the public can accurately identify scientific research papers that can be incorporated into systematic reviews. Such reviews often inform critical government funding and approval decisions.

“As an HIV physician at the Alfred Hospital I know the challenges of delivering health care that is based on the best possible research evidence. Using new technologies and ways of collaborating we are working to make that easier. My previous research shows it is possible to use the power of motivated communities to speed up science and I hope to build on this through my Fellowship.”

The Commonwealth Health Minister’s Award was initiated in 2000. Associate Professor Elliott’s application was the top-ranked application of 452 applicants, of which 60 were funded. Monash University submitted 41 applications of which five were funded in total. Associate Professor Elliott says,“I’m incredibly honoured to receive this award given the extraordinary talent and experience of my fellow applicants. I hope the work arising from it will result in real improvements in the ways research can be translated into better health.”

NHMRC General Manager Tony Kingdon said Associate Professor Elliott’s research achievements make him a highly worthy recipient of the award.“It is a privilege to honour the achievements of an exceptional researcher whose work is making a significant contribution to our understanding of how we can improve the speed and accuracy of translating research into practical outcomes. I congratulate Associate Professor Elliott on this award.”

Associate Professor Elliott has over 90 publications including papers in leading scientific journals such as Nature, Lancet and PLOS Medicine. In the last five years he has been a chief investigator on 20 grants totalling over $8million.

The 2016 Journal Citation Report (JCR) has just been released by Clarivate Analytics (formerly Thomson ISI), and we are pleased to announce that Cochrane Database of Systematic Reviews (CDSR) Impact Factor is now 6.124.

This is a slight increase on the 2015 impact factor, which was 6.103.

The CDSR impact factor is calculated by taking the total number of citations in a given year to all Cochrane Reviews published in the past 2 years, and dividing that number by the total number of Reviews published in the past 2 years. It is a useful metric for measuring the strength of a journal by how often it its publications are cited in scholarly articles.

Some highlights of the CDSR 2016 Impact Factor include:

The CDSR is ranked 14 of the 154 journals in the Medicine, General & Internal category.

The CDSR received 57,740 cites in the 2016 Impact Factor period, compared with 47,899 for the 2015 Impact Factor calculation.

The total number of times the CDSR was cited increased from 47,899 in 2015 to 57,740 in 2015 meaning the CDSR received the 5th highest number of citations in its category.

The 5-Year Impact Factor is 7.018.

The main Impact Factor report and the CRG reports will be delivered after the JCR is updated in September. This is because, as has happened in previous years, Clarivate was unable to accurately index Cochrane Reviews for this Impact Factor window; Wiley and Cochrane are following-up with Clarivate regarding the calculation of the 2016 impact factor.

More information is available here on how the CDSR Impact Factor is calculated.

“This generation, our generation of people who benefited, must always be the pioneers who look to younger people and say mediocrity is not accommodated in what we do.”

Trevor Manuel, who served in the South African government as Minister of Finance from 1996 to 2009, during the presidencies of Nelson Mandela, Thabo Mbeki, Kgalema Motlanthe, and subsequently as Minister in the Presidency under President Jacob Zuma, will be the first plenary speaker at the Global Evidence Summit.

Trevor Manuel will address the Summit in the opening Plenary on Wednesday 13 September, 9am-10.30am.

During his two decades as a Cabinet Minister, Trevor Manuel also served as a Member of Parliament, representing the African National Congress.

His career highlights include major social and economic developments within the South African economy. As Minister of Trade and Industry, he led the process of reintegrating South Africa into the global economy after decades of sanctions and disinvestment. He introduced extensive support measures for small, medium and micro-enterprises to boost local economic development and grow business enterprise.

As Chairperson of the National Planning Commission, he also oversaw the drafting of the broadly-accepted and first National Development Plan for the country.

Mr Manual has held leadership positions within a several international bodies, including the United Nations Commission for Trade and Development (UNCTAD), the World Bank, the International Monetary Fund (IMF), the G20, the African Development Bank and the Southern African Development Community.

He has been internationally recognized for his accomplishments within social and economic development, and holds eight honorary doctorates from South African tertiary institutions in a range of disciplines including Commerce, Law and Technology as well as a Doctor of Laws from McMaster University, Ontario Canada.

Currently, he is an Honorary Professor in the School of Development Policy & Practice at the University of Cape Town where he is also a Senior Political Fellow, and Professor Extraordinaire at the University of Johannesburg.